Short Takes On News & Events

Study: Most Seniors’ ER Visits Could Be Avoided

By Phil Galewitz

October 5th, 2012, 4:13 PM

Nearly 60 percent of Medicare beneficiary visits to emergency rooms and 25 percent of their hospital admissions were “potentially preventable”–  had patients received better care at home or in outpatient settings —  according to results of a study released Friday by a congressional advisory board.

“These are spectacular rates,” said Scott Armstrong, a member of the Medicare Payment Advisory Commission and CEO of Group Health Cooperative, a Seattle-based health plan.

The commission’s preliminary study, released at their monthly meeting, found the most common diagnosis for preventable ER visits was upper respiratory infections. The most common diagnosis for preventable hospital admissions was congestive heart failure.

The potentially preventable admissions or ER visits do not indicate the hospital acted inappropriately. Instead, they are a measure of a community’s outpatient care system that includes private physician offices, community health centers and urgent care centers, study co-author Nancy Ray, a MedPAC principal policy analyst, told commissioners. Ray said not every preventable ER visit or admission can be avoided. The study showed wide variation of these rates across the country and within cities.

Patients could avoid preventable ER visits by having health conditions treated by family doctors or urgent care centers or by making sure to take all their medicine. Hospital admissions could be prevented if conditions such as asthma, diabetes or heart failure were better monitored by patients and their doctors, commission staff said.

The study analyzed health services provided to 5 percent of all traditional Medicare program beneficiaries from 2006 to 2008.  It also looked at care provided to all Medicare beneficiaries in six markets: Boston, Phoenix, Miami, Minneapolis, Greenville, S.C., and Orange County, Calif. MedPAC officials said it would release marketplace details when the report is completed in a few months.

The study found hospitals that had lower occupancy rates had higher rates of preventable ER visits and admissions.  Medicare beneficiaries who also receive Medicaid— a category known as “dual eligibles” — also had higher rates.

Researchers have been looking at reducing preventable ER visits and hospital admissions for years, though this is one of the first large analyses of Medicare patients. Hospitals in 2006 spent $30.8 billion on 4.4 million hospital admissions that might have been avoidable, according to a report by the federal Agency for Healthcare Research and Quality.  A 2006 Rutgers University study found 47 percent of ER visits in New Jersey were potentially avoidable.

12 Responses to “Study: Most Seniors’ ER Visits Could Be Avoided”

  1. samson p. says:

    Why in the world would hospitals and doctors want to help avoid emergency room visits and help avoid hospital re-admissions in a fee-for-service environment? Aren’t they going to get paid regardless? Doctors and hospital administrators could not care less how many times a patient uses the emergency room or how many times a patient is re-admitted to the hospital because of medical mistakes. They get paid no matter what! That’s why they are fighting the Affordable Care Act (ACA) so much and are lobbying Republicans to repeal it. The ACA makes doctors and hospitals more accountable. Why would doctors and hospitals want to become more accountable? They’d be crazy to want healthy patients. Healthy patients don’t create wealth, right? That’s why doctors and hospitals say, the sicker, the better!

  2. Mark Ketterer, PhD says:

    It is certainly true that the financial incentives for doctors and hospitals are perverse -
    encouraging more rather than conservative care. But the motives of doctors, like all
    human beings, are complex. They are generally taught to do everything that might benefit the patient (without appropriate concern for potential iatrogenic harm), are terrifed
    of being sued for not doing enough and live in a professional culture that glorifies the
    guy who has mastered the next whiz-bang high-tech toy. What is most ennabling of
    overtreatment, and lack of concern for preventing illness, is the lack of valid clinical science. The estimates are that 80% of what is done in our system has not been tested and proven to be beneficial. When doctors deliver care based on biological theory rather
    than clinical trials, anything goes. Thomas Jefferson was america’s first ardent advocate of evidence based medicine – “it is in this part of Medicine that I wish to see a reform, an abandonment of hypothesis for sober facts, the first degree of value set on clinical observation, and the lowest on visionary theories.”

  3. Anne Kinzel says:

    I love this study and am looking forward to reading the entire report. The tragedy of our country’s approach to health care is the surfeit of unnecessary and avoidable health care that is the result of overfunding tertiary and quaternary care at the expense of primary and secondary care.

    The only system that will adequately fund primary and secondary care is a tax based insurance system. Simply put, in those systems the tax payer will dismiss a government with inadequate primary and secondary care. Why is that? This is where voters are most likely to intersect with the health care system.

    Overfunding rare care is a losing proposition in tax payer funded systems. It is a winning proposition when private insurance dominates as it will result in higher premiums.

  4. Angel Braña says:

    It is fascinating to see/ read how we as a Nation / society/ guild of “experts” / academia etc etc etc keep beating the bushes looking for a magic answer on how to be more efficient doing research to keep findinding the same obvious results: care coordination and early access to care avoids complications and lowers costs!!! It’s laughable to read so much analysis that shows the same results… Tha incentives in the whole industry is to do more because that is what brings the money to every single stakeholder “except” the tax payer -we the people- that pick up the tab for so much inefficiency… Whether in high insurance premiums, lower salary wages to pay for the issurance “benefit”, and all sort of tax based reimbursement mechanisms to pat for the uninsured or uncompensated care! Come on people… What is the problem in understanding that it behooves all of us as a society to bring all of us under the same financial risk pool so that then we all decide to apply evidencenbased medicine to every one of our member in the society!!!

    Of course… Left to the controllers of the economic equation NOTHING is ever going to happen BECAUSE all but the tax payer make money maintaining the status quo while at the same time pretending looking for solutions in studying and finding the same thing. OF COURSE CARE COORDINATION, PREVENTIVE HEALTH MEASURES AND EARLY ACCESS TO CARE decrease the total burden of disease and COST! What is the surprise????

  5. One problem area not addressed is nursing homes, assisted care facilities, et al. I’ve found that if a patient in one of these facilities becomes ill, neither his/her personal doctor nor the facilitiy’s medical director is called to treat the patient. Rather, s/he is immediately transferred to an ED incurring potentially unnecessary treatment and transport costs. If the patient is admitted, even for observation, then the family has to pay a “bed hold” fee, another expense, to assure that the patient can return to the facility.

  6. P. Boyles RN says:

    I am a little frightened by the attitude of this study. I do appreciate the necessity of responsible use of funds. However, I have a little trouble with the focus of this article. The focus should be on optimal health of the patient regardless of age. The active healthy 80 year old deserves good, agressive care just as much as the 30 year old obese smoker. It seems to me the real issue is GOOD Health Management in the primary care setting. All patients should be required to have a primary care physician of their choice. The primary care physicians should be given the time to manage their patients in the outpatient setting. When patients can access their physicians and the physician feels responsible for the patient’s health, those pateints, regardless of age, will ultimately utilize the ED less. There should be programs in place for teaching and monitoring that the primary care physician could and should be utilize. Most Hospitals have incorporated programs to assist patients with chronic conditions at discharge. However, the primary care physician having a relationship and working with the patient, is key to keeping patient’s at their maximum stte of health and out of the hospital.

  7. Stephen T. Mennemeyer Ph.D. says:

    The problem here is one of monday-morning quarterbacking: how is the patient, at-home to know if he/she should go to the ER? Major public health campaigns are at work telling people about the signs and symptoms of stroke and heart attack and urging people to be safe and call 911 if various symptoms apppear. There are bound to be lots of ER visits that turn our to be false positive upon physical exam but which may have seemed perfectly reasonable for an ER visit to the patient experiencing symptoms at home or to the physicain who might have been contacted by telephone. What, for example, should a patient do who is experiencing dizziness with difficulty in breathing?

  8. Alyse Lopez-Salm says:

    I am a MPH student who recently viewed an important film that addresses our broken healthcare system and provides potential solutions for beginning to fix it. Please see:

  9. Catherine Price says:

    I have living this reality as the adult caregiver for my mother. The physicians’ offices do not want to deal with many of these issues on an outpatient basis either because they are not reimbursed for doing so. If you call and the physician is not available (which is most of the time) the staff is instructed to tell you to take the person to the ER. I often have to argue with staff to get the right thing done. Sometimes the fixes are relatively simple and straight forward but there is no one to make the call for the patient. The elderly are time consuming for physicians because they have many complex problems which take time to sort through. The person may have reduced cognitive function and many do not have family, friends or healthcare workers to advocate for them and the staff are already stretched for time. So, the answer is to send them to the ER. Then in the ER they often get inappropriate care or (when they have good health insurance coverage) so much care that the care itself can become dangerous (ex. heart catheterizations because the hospitals get a good reimbursement for this service). I have been working in a small free clinic for several years. In the last three months of my father’s life, the cost of his medical care exceeded the annual budget of our clinic and we provided 1200 primary care visits last year. Thing are definitely a little out of control! Maybe government is bureaucratic and costly but the private sector surely is not going to fix this problem because our healthy private sector has created this problem.

  10. Richard Titus, RN says:

    I’ve read through the remarks, and many good points are made.

    Part of the problem lies with the physicians themselves. For years physicians (even the ones on call) have told patients for problems after hours to go to the emergency room. This covers them legally if anything goes wrong. Patients are often just doing as they are told. We are living longer due to advances in medical science and tecnology. With longer life comes the inevitable system failures of organs that just wear out. Couple failing systems, including mental degeneration, and patients and their families often times don’t know what to do when exacerbations of illness occur and 911 is the only thing that enters their minds (remember, even on call physicians often tell their patients to go to the emergency room). We seem to be at a point in patient care, with all of the advances and technology, that we are reluctant to admit when it is a losing battle and it is time to die. And, I am not just talking about medical caregivers, but patients and families in general. Do we need to include end of life issues earlier in disease management, or is the public not yet ready? Fear of “death panels”? The are a host of reasons that people overuse emergency rooms just as there are reasons that 15% of the population uses 75-85% of health care dollars. Who do we need to educate? How and who do we restrict? When do we say no?

  11. Catherine says:

    I think everyone here has made many valid points. With that said, I also get the sense that there is some finger pointing going on. The reality from where I sit, working in a Retirement Community, is that doctors, families and residents alike look to the Retirement Community to solve ALL health care problems and needs. In earlier times our parents cared for their parents. Fast forward and now you have people living longer, they want options, want to live “independently”, adult children are overstressed with their own lives and are looking for help with aging parents. The Retirement Community CANNOT be all things to all people and is feeling the strain caring for residents that TRULY require more care, but the family, doctor and the resident refuses to acknowledge this. So you have an aging population waiting until past the time they really need the help, moving into Retirement Communities that are not make-shift hospitals. And yes I hear all the time from doctors to send their patient our resident to the ER. 1# they cannot diagnois over the phone, 2# the responsibility for a higher level of care (at least temporarily) falls at the Retirement Community, that cannot act without Physicians orders (malpractice) (lab tests) mapractice (treatment onsite?) potential malpractice! People need to wake up and smell the coffee at the morning get together. EVERYONE needs to take responsibility in finding a solution. As a cautionary tale, I would imagine that given a choice most people want to live and die with their dignity intact and without multiple pointless operations, this could be a good place to start.

  12. Jack Mac says:

    The Affordable Care Act has put measures in place to combat the high number of hospital readmissions and begin the move towards a pay-for-performance model:
    More than 2,200 U.S. hospitals stand to lose a combined $280 million next year because of CMS (Centers for Medicare & Medicaid Services) penalties for excess readmissions, according to a Kaiser Health News analysis that broke down the penalties by state: